Online Exclusive: Is your birth control right for your age and lifestyle?

It’s Your Choice

By Anna Zernone Giorgi/HealthyLife

Despite the availability, convenience and effectiveness of women’s birth control options, almost half of U.S. pregnancies are unplanned, according to the American Congress of Obstetrics and Gynecologists (ACOG). Surprisingly, half of these pregnancies occurred in women who were using birth control at the time of conception, though probably inconsistently or incorrectly.

If you are a woman who wants to avoid an unintended pregnancy, it’s likely that you will have to use birth control for about three decades of your life, ACOG reports. However, only consistent and correct usage will give you optimum effectiveness.

“A patient needs to discuss with her health care provider her lifestyle and how good she is with being compliant withmedication, and try to discuss those options, because with any medication or any birth control, number one, you need to be compliant. If you’re not compliant, the efficacy of that particular product is going to go down significantly,” says Dr. Robert Goldberg, an obstetrician/gynecologist with the Avery Center for Obstetrics and Gynecology in Westport, Norwalk, Fairfield and New Canaan.

In addition, to help maintain effectiveness it’s important for patients to contact their health care provider about issues related to side effects or interruptions in usage, such as a missed birth control pill, Goldberg says. “They really should call their health care provider immediately to discuss what’s normal, what’s not normal, or how they should proceed for different scenarios.”

Understanding the available options and how they work can help you team with your health care provider to find the best option for each stage of your life. Here’s a breakdown on different types.

Sterilization

Tubal Ligation

What It Is: The fallopian tubes are cut and tied with thread, sealed with an electric current, or blocked with bands or clips.

How It Works: When the tubes are sealed, an egg can’t travel down to the uterus where it can be fertilized and the sperm can’t reach the egg.

How It’s Administered: It’s typically done with a laparoscope, through small incisions in the abdomen.

Benefits: The effects are immediate and permanent.

Downside: Tubal ligation is considered irreversible so you must be sure of your choice. There is a slight increased risk for ectopic pregnancy.

What It Is: A small silicone (Adiana) or metal (Essure) device is inserted into each fallopian tube.

How It Works: Scar tissue forms around the implanted devices and blocks the fallopian tubes.

How It’s Administered: A special instrument, inserted through the vagina and up into the uterus, allows access to the fallopian tubes and proper placement of the devices.

Benefits: No surgical incisions are necessary, so recovery time is minimal, with a low risk of infection and bleeding.

Downside: Because it takes three months for the scar tissue to form, you must use a backup form of contraception until your health care provider confirms sterilization.

Why You Should Consider It: The non-surgical, hormone-free technique is permanent and 99 percent effective.

Noteworthy: While either form of sterilization is convenient and frees you from maintenance, the fact that sterilization is irreversible must be understood. “There’s a bit of a misconception about the idea of tubal ligation in that, though it is reversible, it’s not always successfully reversed; it’s generally not covered by insurance; and it’s extremely expensive to reverse,” says Dr. Russell Turk, an obstetrician/gynecologist with Riverside Obstetrics and Gynecology in Riverside. “For anybody who brings up the idea that this is reversible, we [gynecologists] drill it into their head that, if you’re even thinking about the possibility of reversing it, then you shouldn’t really be considering this procedure because it should be considered permanent.”

Hormone-Based Options

The hormone progestin is a key ingredient in hormone-based birth control. Options that contain progestin thicken the mucus of the cervix and thin the lining of the uterus. These effects work to keep sperm from joining the egg. Progestin-only pills and systems can be useful if you can’t tolerate the side effects of estrogen or are limited by medical concerns, such as breastfeeding.

Combination pills and systems that contain progestin and estrogen also work to prevent your ovaries from releasing an egg. They usually require one week off, when bleeding occurs. Some formulations of the combination pill allow you to reduce the number of periods you have in one year.

Oral Contraceptive

What It Is: Oral contraceptives are prescription pills that contain hormones.

How It Works: Combination pills contain estrogen and progestin; the mini-pill contains only progestin. Continuous-dose or extended-cycle pills allow you to have fewer periods. On days when you don’t take a pill or take a placebo, you will have your period.

How It’s Administered: A pill is taken at the same time every day. 21-day combination pills are taken for 21 days, followed by 7 days off. Other options are taken every day for 28 days, including 7 inactive pills. Extended-cycle pills are taken for three months before inactive pills are added. Continuous-dose pills are taken every day for one year.

Benefits: Birth control pills help to regulate and minimize menstrual bleeding. They may be helpful in treating other medical conditions, including painful periods, fibroids, endometriosis, and even acne and unwanted hair growth.

Downside: You must remember to take a pill at the same time every day. Break-through bleeding is common when starting and may continue. Combination pills can increase your risk for heart attack and stroke.

Why You Should Consider It: The pill is 91 to 99 percent effective, free of devices and can be discontinued easily for a return to fertility.

Noteworthy: There is no validity to common misconceptions that the pill will cause cancer or weight gain, Turk says. “The biggest misconception is that it’s cancer-causing, which for the most part, even when they [researchers] really manipulate the data in many different ways, it’s pretty hard to say that the pill causes breast cancer,” he says. “The other misconception about the pill is the long history that it causes weight gain. When they look at 1,000 women who are on the pill and 1,000 women who are off, they both gain weight in the same amounts.”

Injection (Depo-Provera)

What It Is: There are two types of injections: one is given deep into your muscle; a newer version is administered just below the skin.

How It Works: The injection contains progestin.

How It’s Administered: It is given by your health care provider once every three months.

Benefits: You don’t have to worry about contraception for three months.

Downside: You can’t use the injection for more than two consecutive years because it can cause a temporary loss of bone density.

Why You Should Consider It: The injection is 94 to 99 percent effective. It is a very low- maintenance, reversible option that is estrogen-free.

Subdermal Implant (Implanon or Nexplanon)

What It Is: The implant is a flexible, plastic rod that is inserted under the skin of your upper arm. It’s about the size of a matchstick and usually can’t be seen when in place.

How It Works: It releases a steady dose of progestin.

How It’s Administered: It must be inserted and removed by a health care provider. Insertion takes about one minute. Removal requires a local anesthetic and a small incision, and takes about five minutes.

Benefits: The hormone supply lasts for up to three years. Then, the rod must be removed. If it is not replaced immediately, you can regain fertility relatively quickly.

Downsides: The implant may cause irregular bleeding, resulting in periods that are heavier and/or longer, or periods that are lighter and/or less frequent.

Why You Should Consider It: The implant is a long-term, 99-percent effective option that’s easily reversible and estrogen-free.

Vaginal Ring (NuvaRing)

What It Is: The vaginal ring is a flexible, transparent plastic ring that is inserted deep in the vagina.

How It Works: It releases a steady dose of estrogen and progestin.

How It’s Administered: Though a prescription is required, you won’t need to be fitted. You insert the ring, similar to inserting a tampon, and leave it in place for 21 days. Then, you remove it for seven days, and bleeding occurs.

Benefits: It provides a steady dose of hormones which, when discontinued, allow for fertility to resume relatively quickly.

Downside: You must be comfortable with inserting it in place.

Why You Should Consider It: The vaginal ring is 91 to 99 percent effective, latex-free, and requires maintenance only monthly.

Noteworthy: “We’re fortunate in the last five to 10 years that there are a lot of good forms of birth control on the market that are more technically aimed at not failing because the user doesn’t use them right,” Turk says. “That would include hormonal options such as the NuvaRing, where, instead of having to remember to take a pill each night, you just put the ring in your vagina and you leave it there for three weeks.”

Transdermal Patch (Ortho Evra)

What It Is: The patch is an adhesive square, about 1.75 square inches in area, that is affixed to your upper body, outer arm, lower abdomen or buttocks.

How It Works: It releases a steady dose of estrogen and progestin.

How It’s Administered: It requires a prescription, but is self-administered on a four-week cycle. You use a new patch once a week for three consecutive weeks. You don’t apply the patch on the fourth week, which causes menstruation to occur.

Benefits: The patch doesn’t require daily maintenance. When discontinued, it allows for a quick return to fertility.

Downsides: You are exposed to a higher level of estrogen than with combination birth control pills.

Why You Should Consider It: The patch is 91 to 99 percent effective, regulates ovulation, and is easily self-administered.

Intrauterine Device (IUD) (Mirena and ParaGard)

What It Is: An IUD a form of long-term birth control. It is a T-shaped plastic frame that is about 1 ¼ inches long. It has a string on the end so you can check that it is in place.

How It Works: Mirena releases progestin; ParaGard releases copper. Both work to prevent the sperm from reaching and fertilizing an egg. They also prevent a fertilized egg from successfully implanting in the lining of the uterus.

How It’s Administered: Both types of IUDs require insertion in the uterus and removal by a health care provider.

Benefits: Mirena can remain in your uterus for up to five years. It releases progestin directly into your uterus, so your entire body isn’t exposed to hormonal effects. ParaGard can remain in your uterus for up to 10 years. After IUD removal, you typically can return to fertility quickly.

Downside: If you do get pregnant unintentionally, you are at a higher risk of ectopic pregnancy when using an IUD.

Why You Should Consider It: The IUD is a very long-term, 99-percent effective, reversible option. ParaGard offers these benefits without hormones.

Noteworthy: A new form of IUD, called Skyla, was made available to patients earlier this year. Though smaller in size, the device works similarly to Mirena, offering an IUD that releases progestin, though only for three years. “It’s great that there is now an IUD that is actually smaller and easier to insert in younger women and women that have never had any babies before. It’s something that is safe-use and will not affect their future ability to have a family when they’re ready to have a family,” Goldberg says. “For someone that’s looking for longer-term contraception and looking for something easy to use, it’s a great new form of birth control.”

Barrier Methods

After sterilization and birth control pills, barrier methods are the most common forms of contraception. It’s important to note that, of all methods of contraception, only the male latex condom is proven to help protect you from the spread of HIV and sexually transmitted diseases (STDs). The female condom also may offer some protection.

What It Is: Barrier methods, which include diaphragms, cervical caps, sponges, male and female condoms, and spermicides, prevent sperm from passing through the cervix to fertilize an egg.

How It Works: Diaphragms, cervical caps, and sponges cover the opening of the cervix and are used in conjunction with spermicide. Condoms form a physical barrier against the sperm.

How It’s Administered: Diaphragms and cervical caps must be prescribed and fitted by a health care provider, though you insert them yourself before intercourse. The sponge, spermicides, and female and male condoms are available without prescriptions.

Benefits: These options are free of hormones and used only before intercourse.

Downside: Effectiveness can be unpredictable, though incorrect and inconsistent usage often

contributes to failure.

Why You Should Consider It: These hormone-free options range from 80 to 98 percent effectiveness when used correctly and consistently. The male and female condoms can prevent the spread of STDs.

Noteworthy: For patients who are at risk for STDs, having protection from infection shouldn’t get forgotten in the need to have protection from unplanned pregnancy. By ignoring the need to use a condom, regardless of your using another form of birth control, you may be risking your future fertility. STDs like HPV, gonorrhea, and chlamydia, can have long-term consequences that can lead to infertility, Goldberg says.

“I always stress to my patients that you can’t tell by looking at someone whether or not they have an STD…so you always need to protect yourself from STDs,” he says. “[Another birth control option] will protect you from getting pregnant, and it’s great as a backup form just in case a condom were to break if there’s a problem, but it really shouldn’t lead to where you are comfortable not using condoms.”

An interactive online tool, accessible on the Association of Reproductive Health Professionals’ website, can help you find the right contraceptive options to fit your lifestyle and usage preferences. Visit arhp.org/MethodMatch.